Thirty-five relevant studies involving in total 682 patients with 709 different types of injuries were evaluated in a review to determine the outcomes after immobilisation in a halo vest for various injuries to the upper cervical spine between 1962 and 1998. Studies were analysed according to the type of injury pattern and in terms of the treatment outcomes following primary treatment with a halo vest. The following types of injuries were evaluated: odontoid fractures (n = 420), hangman's fractures (n = 172), other axis fractures (n = 75), Jefferson fractures (n = 26), C1 arch fractures (n = 9), atlantooccipital (n = 2) and atlantoaxial dislocations (n = 5). The ligamentary atlantooccipital dislocations never healed. All isolated Cl ring fractures healed completely. The isolated C1 arch fractures healed in 83% of the cases. The ligamentary atlantoaxial dislocations had a 60% rate of healing. Healing was noted in all isolated odontoid type I fractures, 85% of the isolated odontoid type II fractures, and 67% of the odontoid type II fractures with combined injuries. The isolated odontoid type III fractures had a 97% healing rate. The non-classifiable odontoid fractures had a healing rate of 85%. The stable C2 arch fractures (hangman's fracture) healed consistently in 99%, and 90% success was found for other C2 fractures. A halo vest can be recommended for patients with isolated Jefferson fractures, hangman's fractures, odontoid type III and type II fractures, with a low dislocation rate. The results of treatment with a halo vest were unsatisfactory with regard to combined injuries with an odontoid type II fracture. An overall healing rate of 86%, however, allows one to conclude that this treatment continues to be a good alternative to operative stabilisation of bone injuries to the upper cervical spine.

1 Human brain cortical slices from patients undergoing neurosurgery for treatment of epilepsy resistant to antiepileptic drugs were used to identify and characterize N-methyl-D-aspartate (NMDA) and non-NMDA receptors mediating stimulation of noradrenaline release. The slices preincubated with[3H]-noradrenaline were superfused with Krebs-Henseleit solution with or without Mg2" (1.2 mmol 1-') and were stimulated by 2-min exposure to NMDA, kainic acid or (RS)-a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA). 2 In slices superfused without Mg2+, NMDA induced a concentration-dependent tritium overflow. 3 The NMDA-evoked tritium overflow was almost abolished by tetrodotoxin (TTX), Mg2+ or by omission of Ca2" from the superfusion fluid. 2-Amino-5-phosphonopentanoic acid (AP5; a competitive NMDA receptor antagonist) or dizocilpine (formerly MK-801; an antagonist at the phencyclidine receptor within the NMDA-gated ion channel) inhibited the NMDA-evoked tritium overflow. The stimulatory effect of NMDA was not significantly enhanced by glycine added to the superfusion fluid but was reduced by 7-chlorokynurenic acid (an antagonist at the glycine site coupled to the NMDA receptor).4 In slices superfused with solution containing Mg2", kainic acid or AMPA induced a concentrationdependent tritium overflow which was susceptible to blockade by TTX. 5 The kainic acid-evoked tritium overflow was not affected by DL-(E)-2-amino-4-methyl-5-phosphono-3-pentanoic acid (CGP37849; a competitive NMDA receptor antagonist), but was inhibited by 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX; an antagonist at glutamate receptors of the non-NMDA type). 6 The AMPA-evoked tritium overflow was also inhibited by CNQX. 7 It is concluded that NMDA receptors as well as kainate-and AMPA-recognizing non-NMDA receptors stimulate noradrenaline release in the human brain cortex.

In 42 patients with a spinal neurinoma or neurofibroma, resection of the affected nerve root was necessary in 24 cases for complete removal of the tumour. In 10 of these the resected nerve root was relevant for upper or lower limb function. Of this subgroup of 10 patients with a resection of a relevant motor root, only 4 showed an initial slight impairment of motor function, which was followed by complete recovery in two cases by the time of discharge from hospital. A persisting relevant motor impairment was not observed in any case. Recommendations given in the literature for the resection of spinal neurinomas vary from radical resection to strict microsurgical resection with preservation of as much of the nerve root as possible. This report together with the publication of Kim et al. suggests, that radical resection is possible without neurological deficit, if microsurgical preservation of unaffected nerve fibres is impossible or if the risk of recurrence is judged to be unduly high.

Long-term results of cervical interbody fusion with PMMA were evaluated in a retrospective study. X-ray films of 83 patients were obtainable. Post-operative follow-up in this series was between 15 and 20 years. The results show that PMMA is engrafted after about 2 years. Stable vertebral interbody fusion is obtained in about 90% of cases. Development of malignoma was not observed. Resorptive bone alterations, which can be seen in about 2% of cases one to two years after operation are shown not to be progressive. This process heals and stable fusion develops.

Background:Tympanojugular paragangliomas (TJPs) are benign, highly vascularized lesions located in the jugular foramen with frequent invasion to the temporal bone, the upper neck, and the posterior fossa cavity. Their natural history, surgical treatment, and outcome have been well addressed in the recent literature; however, there is no consensus regarding the optimal management while minimizing treatment-related morbidity. In this study, we assessed the interdisciplinary microsurgical treatment and outcome of large TJP collected at a single center.Methods:Out of 54 patients with skull base paraganglioma, 14 (25%) presented with large TJP (Fisch grade C and D). Posterior fossa involvement was present in 10 patients (Fisch D). Eleven patients presented with hearing loss, two patients with mild facial nerve palsy, and two patients with lower cranial nerve deficits. Two other patients with previous surgery presented with tumor regrowth.Results:Preoperative embolization was performed in 13 cases. Radical tumor removal was possible in 10 patients. Hearing was preserved in four patients with normal preoperative audiogram. The facial nerve was preserved in all patients. Temporary facial nerve palsy occurred in two patients and resolved in long-term follow-up. In three patients, preexisting facial nerve palsy remained unchanged. Persistent vocal cord palsy was present in three patients and was treated with laryngoplasty. The global recovery based on the Karnofsky performance scale was 100% in 10 patients and 90% in 4 patients.Conclusion:Preoperative embolization and interdisciplinary microsurgical resection are the preferred treatment for selected patients due to high tumor control rates and good long-term results.